Provider Demographics
NPI:1083503825
Name:CAROL M LAZO, LICENSED PROFESSIONAL CLINICAL COUNSELOR P.C.
Entity type:Organization
Organization Name:CAROL M LAZO, LICENSED PROFESSIONAL CLINICAL COUNSELOR P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:M
Authorized Official - Last Name:LAZO
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:424-488-6422
Mailing Address - Street 1:13389 FOLSOM BLVD
Mailing Address - Street 2:#200
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630
Mailing Address - Country:US
Mailing Address - Phone:424-488-6422
Mailing Address - Fax:213-652-6332
Practice Address - Street 1:720 WILSHIRE BLVD STE 204
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1737
Practice Address - Country:US
Practice Address - Phone:424-488-6422
Practice Address - Fax:213-652-6332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-28
Last Update Date:2025-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & SportsGroup - Multi-Specialty